All about morning sickness

What is morning sickness?

Let’s clarify from the outset that ‘morning sickness’ (also known as Nausea and Vomiting of Pregnancy) is NOT restricted to the a.m. Many newly pregnant women are rudely shocked when nausea strikes them not only upon waking, but also after lunch, during the train commute home from work, when cooking dinner or, indeed, 24/7.

Most pregnant women experience some level of unsettling nausea during the first trimester, with about 50 percent enduring vomiting or retching bouts.

Women pregnant with twins or triplets can have more pronounced symptoms.

There is no evidence that the sex of the baby has an impact on the severity of morning sickness.

What is Hymeremesis Gravidarum?

A very unlucky few pregnant women – between 0.5 and 3 percent – develop the very serious condition, Hyperemesis Gravidarum (HG). HG sufferers are barely able to hold down any food or liquid and are thus at risk of dehydration, electrolyte imbalances, even malnutrition. Where morning sickness sufferers are able to maintain their weight, experience only episodic vomiting, and often feel better during the second trimester, HG-afflicted women have their lives profoundly disrupted (sometimes for the entire pregnancy) and are often hospitalised. As with morning sickness, the exact reasons why HG develops are unknown. The long-standing assumption (unfortunately still prevalent amongst some medical care providers), that the condition is psychosomatic, is incorrect.

What causes morning sickness?

There is no clear cause for morning sickness. Studies have suggested a complex symphony of increased levels of estrogen and progesterone, low blood sugar and low blood pressure bring on nausea. That the risk of miscarriage is reduced in morning sickness sufferers also indicates an evolutionary protective function: mothers’ increased sensitivity to food and smells ensures babies aren’t exposed to plant-based toxins. While it is nearly impossible to predict whether a woman will develop HG in her first pregnancy, those with a history of migraines may be more susceptible. There may also be a genetic component, with mothers, daughters and sisters frequently suffering similarly severe symptoms. Many women who suffer morning sickness in their first pregnancy, will do so again during subsequent pregnancies.

How long does morning sickness last?

Morning sickness usually occurs between weeks six and 12 of pregnancy, but there is no hard and fast rule. Some women remain well into the second trimester, others experience a resurgence of nausea in the final trimester, and a small few are still sick on the delivery table and even in the first postpartum days.

Some tips for alleviating morning sickness

You often hear of sick pregnant women eating huge amounts of salty, greasy fast food in order to feel better. But for cases at the more extreme end of the morning sickness spectrum, such meals are unlikely to stay down, and if they do, will contribute to unnecessary weight gain. So before you start imbibing multiple fried chicken schnitzel wraps, try the following:

Eat a couple of dry crackers when you wake up in the morning. Then rest for 10-20 minutes before clambering out of bed.

Liquid supplements and puddings, sports drinks, and protein bars may prove easier to keep down – and will replace some of those depleted vitamins and electrolytes.

Drink as much water as possible. This can be easier said that done. Experiment with ice chips or icy poles if the taste, temperature or texture of water has you heaving.

Citrus smells may be helpful. Try sniffing lemons, adding lemon slices to water, or burning some lime or lemon citrus oils (get professional advice from a qualified aromatherapist first).

Tea made from grated ginger root has a reputation for settling upset tummies, but don’t expect miracles.

If you notice times of the day when you don’t feel quite so hideous, plan to make and eat your meals then.

What to avoid

An overly full stomach. Try not to consume large meals and liquids at the same sitting. First eat, wait 20 minutes, then drink.

Foods that make you nauseous (a no-brainer, right?). Ignore your well-meaning aunt or friend’s advice regarding the miraculous benefits of cucumber or borscht soup if the thought of either has you lurching to the loo.

Cooking or preparing meals. Enlist the help of your partner or children to make (or fetch) the evening meal. Remember, you don’t have to do everything.

Fatty or spicy foods.

Tight clothing that restricts the abdomen. This is your time to embrace the muumuu (kaftan).

Tiredness and stress. If there is the remotest possibility of reducing your work hours, offloading your preschooler to a relative during the day, or having a neighbour exercise your dog, seize it.

Acid reflux (or heartburn). This can lead to nausea and vomiting.

Have a pack of chewable antacids at the ready. Most antacids are safe to take while pregnant, but check with your pharmacist or doctor first.

The impact of morning sickness on sufferers’ health and quality of life

With such a crazy regime revolving around the purchase, preparation, avoidance, scheduling and throwing up of food, it is inevitable that many sufferers become physically and emotionally affected.

Nausea and vomiting can render women exhausted and sore from the constant effort of heaving. While strain on the body’s organs has a temporary effect, there is a risk of permanent teeth damage from stomach acids. Morning sickness commonly causes a significant loss of pre-pregnancy weight (sometimes exceeding 5 percent in HG sufferers).

The significant disruption to daily routines, and inability to work or care properly for children, also leaves many morning sickness sufferers susceptible to depression and anxiety.

What about the impact on the fetus?

Only in cases of HG-induced maternal malnutrition or dehydration is the fetus at risk. Otherwise, it generally receives its nutritional requirements (unfortunately often at the expense of the mother). The violent physical action of vomiting does not affect the fetus as it is comfy and protected in its amniotic sac.

Seeking help

An unfortunate attitude amongst many stoically sick pregnant women is that they are enduring something completely normal and should just tough it out like millions of others. However, if you are ill to the point of incapacitation – even if your daily life is being compromised – it is best to seek medical treatment as soon as possible. Benefits of early intervention include:

Ruling out other non-pregnancy related illnesses or infections such as appendicitis, bowel obstruction, gastroenteritis or kidney infection.

Preventing your morning sickness progressing to a more acute stage.

Avoiding the development of depression and anxiety.

Minimising the financial impact of missed work.

Treatments

Non-pharmacologic treatments

At any stage, you can try the following natural therapies:

Acupressure

Acupuncture

Vitamin B6 (not exceeding 200mg per day)

Ginger root powder, capsules or extract

However, there is little conclusive scientific evidence that these treatments alleviate severe morning sickness symptoms.

Pharmacologic treatments

If a patient’s symptoms are severe enough to warrant medical intervention, her doctor may first try antiemetic or antinauseant drugs (also used to treat motion sickness and the side effects of chemotherapy and general anesthetics).

The first kind of antiemetic drug to be tried may be an antihistamine (also known as a histamine receptor antagonist), such as:

Caffeine-Dimenhydrinate-hyoscine hydrobromide (Travacalm)

Promethazine (Avomine)

If these prove ineffective, a patient may be prescribed a dopamine antagonist, such as

Metoclopramide (Maxolon)

Prochlorperazine (Stemzine, Stemetil, ProCalm)

The final kinds of drugs prescribed for the most severe cases of HG are serotonin receptor antagonists, such as:

Ondansetron (Zofran)

Women are generally only prescribed Zofran once they have been hospitalised for HG and all other treatments have proved futile. As the manufacturers of Zofran have not approved it for use during pregnancy, it is not on the Australian Pharmaceutical Benefits Scheme for HG sufferers. Consequently, the cost is borne entirely by the patient. Some women pay in excess of $5000 to keep their symptoms barely manageable throughout their pregnancy.

Corticosteroids may also be tried at this stage. However, there is little evidence that steroids substantially reduce nausea and vomiting, and they increase the risk for oral facial clefts.

Those poor few women who are so sick they end up hospitalised often get hooked up to an IVF drip administering:

fluid replacement

multivitamin supplementation

antiemetic drugs – first a histamine receptor antagonist, next a dopamine antagonist, then receptor antagonist OR a steroid.

Subsequent pregnancies

It is not possible to predict the severity of morning sickness in subsequent pregnancies or, indeed, if you’ll have it at all. However, if you’re trying for a second child and had a wretched time the first time around, the benefits of preparing for the worst cannot be underestimated.

Try to organise childcare so you’re not solely in charge of a toddler all day, every day

Enlist your partner, close friends and family to help with housework, shopping and meal preparation

Fill your kitchen pantry, handbag and car glove box with snacks

Get your GP up to speed on your pregnancy plans and discuss how he/she can support you should morning sickness strike

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